War-torn Syria may be at risk for a major polio epidemic as civil unrest makes it almost impossible to carry out effective immunization.

The World Health Organization said it has already received reports of an outbreak, the first one in Syria in 14 years, the BBC reports. The Ministry of Public Health said that the government would issue a rapid response to the outbreak, but the violence in some regions makes it difficult to provide medical services. Because of the conflict, vaccination rates have plummeted from 95 percent in 2010 to 45 percent in 2013.

At least a third of the public hospitals in Syria are closed, and up to 70 percent of the medical staff has fled. Also compounding the problem are overcrowding, bad sanitation, and contaminated water.

The suspected polio cases were reported earlier this month in the Deir al-Zour province.